Tuberculous Aneurysm of the Descending Aorta

: A 62-year-old woman visited her primary physician because of high fever and vomiting. From a chest roentgenogram miliary tuberculosis was diagnosed. Anti-tuberculosis drugs were prescribed. Mycobacterium tuberculosis was cultured from samples of sputum. Although she took drugs for 3 months, her symptoms did not resolve and back pain developed. A chest roentgenogram showed an egg-sized mass in the posterior part of the mediastinum. Examination of a chest CT scan showed that the mass was an aortic aneurysm. A graft replacement was done, and histologic examination of the resected specimen showed that it was a tuberculous aneurysm of the descending aorta. Her symptoms disappeared, and she recovered fully. Tuberculous aneurysms are rare: they account for only 0.3% of all aneurysms. This is only the 9th reported case of tuberculous aneurysm successfully treated with surgery in Japan. We must realize that aneurysms are life-threatening complication of miliary tuberculosis.